Why you should care

Because the bloated $3 trillion health care industry is ripe for the scalpel.

By Anjana Ahuja

The Daily DoseJUL 01 2018

In 2009, Atul Gawande received a surprise check for $20,000. It came not from The New Yorker, the magazine for which the 52-year-old Boston-based doctor has been a staff writer since 1998, or from a thankful patient, but from an executive in Warren Buffett’s inner circle.

The money was a token of gratitude for an article titled “The Cost Conundrum,” an analysis of why ballooning health care costs in the U.S. were not matched by commensurate gains. Gawande, an endocrinologist and surgeon at Brigham and Women’s Hospital in Boston and a professor of public health at Harvard, returned the check — only to receive two in return. The $40,000 went to charity.

This episode may have seeded the announcement that Gawande is to be chief executive of a nonprofit venture funded jointly by Amazon, Berkshire Hathaway and JPMorgan Chase & Co., formed to address the health of their combined million-plus workforce.

[Gawande] has a real sense of the power of medicine to improve the world. And he’s become fantastically successful without becoming obnoxious.

Andrew Franklin, founder of Profile Books

“I have devoted my public health career to building scalable solutions for better health care delivery,” Gawande says. “Now I have the backing of these remarkable organizations to pursue this mission with even greater impact.… This work will take time but must be done. The system is broken, and better is possible.”

Other than boosting employee health and cutting costs, the prescription for the as-yet-unnamed Boston venture is unclear. But the bloated $3 trillion U.S. health care industry is seen as ripe for the scalpel. Gawande — who has written four best-selling books on medicine, founded projects to improve health in developing countries and received a MacArthur Foundation “genius” award — will now have a generously funded test bed to think differently. The involvement of Amazon suggests technological disruption; bricks-and-mortar hospitals seem, literally, an outmoded operating system in a digitized world.

It is an unexpected direction for the doctor who was tipped to be surgeon general in a Hillary Clinton administration. “I don’t think it’s excessive to call him our most distinguished living doctor,” says Andrew Franklin, a friend and the founder of Profile Books, which publishes Gawande’s works in the U.K.

“He has a real sense of the power of medicine to improve the world. And he’s become fantastically successful without becoming obnoxious. I don’t have many heroes, but Atul is one of them,” Franklin says.

Gawande was born in 1965 in New York City — the family later moved to rural Ohio — to immigrant Indian doctors: His father, Atmaram, was a noted urologist, his mother, Sushila, a pediatrician. The couple supported philanthropic causes in the U.S. and India. The young Atul resisted following in their footsteps, studying political science and biology at Stanford (his sister, Meeta, became a lawyer) and volunteering in Democrat circles. A Rhodes scholarship whisked him to Balliol College, Oxford, for a master’s in philosophy, politics and economics.

But the call of medicine proved too strong. By the mid-1990s, Gawande had secured his medical degree from Harvard and dabbled in health policy for Bill Clinton’s presidential campaign. He had also met Kathleen Hobson, a literature graduate whom he later married. The couple have three children, one born with a heart condition, which has afforded Gawande a view from the other side of the operating table. Last year, he tweeted pointedly to his 252,000 followers that his son was one of the uninsurables. His most recent book, Being Mortal, addressed aging and death, partly through the experience of watching his father succumb to cancer.

It was his friend Malcolm Gladwell who first persuaded him to write, initially for the internet magazine Slate and later for The New Yorker. Gawande quickly garnered public acclaim and awards for elegant essays on public health and medicine. Books expanded his reach: His first two, Complications and Better, focused on his experiences as a surgeon and brought an aura of humility to a profession known for its swagger. His third, The Checklist Manifesto, advocating a policy usually associated with aviation safety, became a manual for medical reform. Hospitals that took such basic steps as confirming a patient’s name before an operation found their death rates nearly halved. Major surgical complications fell by a third. The idea was taken up by the World Health Organization, for which Gawande became an ambassador.

Ara Darzi, the pioneering surgeon and advocate of National Health Service reform in the U.K., says Gawande has “altered public and professional perceptions of the culture of modern medicine.” One health professional described him as “confident without being slick.”

He is also ferociously organized, slicing his diary into 10-minute segments; he reportedly writes during the 45-minute turnround between operations. Running things is not his métier. But Ashish Jha, director of Harvard’s Global Health Institute, detects method in the managerial madness: “If they had a detailed strategic plan, Atul would not be the guy to execute it. But they do have someone with a broad vision … and as brilliant a communicator as you can get.”

When asked about screwing up, Gawande said last year that he had failed at two things: philosophy and songwriting. He was once in a rock band whose many names included Thousands of Breaded Shrimp, and wrote dirges while abroad, pining for his girlfriend. “The songs were terrible,” he recalled. But he still got the girl.